As heroin use has surged in Eureka, Calif., residents have complained of finding discarded syringes around town and have blamed a clean-needle exchange program. One lay on the ground behind the public library.CreditCreditMax Whittaker for The New York Times

Needle by Needle, a Heroin Crisis Grips California’s Rural North

Surging opioid use and homelessness are driving an epidemic of despair in parts of the state that are short of housing, treatment options and patience.

As heroin use has surged in Eureka, Calif., residents have complained of finding discarded syringes around town and have blamed a clean-needle exchange program. One lay on the ground behind the public library.CreditCreditMax Whittaker for The New York Times

EUREKA, Calif. — The dirty needles can be found scattered among the pine and brush, littering the forest floor around Eureka, a town long celebrated as a gateway to the scenic Redwood Empire. They are the debris of a growing heroin scourge that is gripping the remote community in Northern California.

While the state as a whole has one of the lowest overall opioid-related death rates in the country, a sharp rise in heroin use across the rural north in recent years has raised alarms. In Humboldt County, the opioid death rate is five times higher than the state average, rivaling the rates of states like Maine and Vermont that have received far more national attention.

The problem is exacerbated here in Eureka, the county seat, by a sizable homeless population that is growing amid an extreme lack of affordable housing and a changing, weakened economy that relies heavily on tourism. The combined ills have devastated a particularly vulnerable community that is often overlooked in the state. Now those problems are spilling into public view, sparking grievances and anger among the town’s residents.

“I’ve lost so many people to this,” said Stacy Cobine, 46, who has battled her own chaotic drug use and been chronically homeless.

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Stacy Cobine walked through the former site of the Devil’s Playground, a longtime homeless encampment where she lived for years on the outskirts of Eureka. The city cleared away the encampment in 2016.CreditMax Whittaker for The New York Times

[Read about the reporter’s journey from covering opioids in the Bronx to rural California.]

Intravenous drug use has been a persistent menace across rural California for decades, but longtime drug users who once sought methamphetamine — which is also often injected — are increasingly looking to score heroin or opioid pills instead. An astonishingly high rate of opioid prescription in Humboldt County has bred addiction, officials said, and the craving is increasingly sated by a growing market for heroin.

While meth “is still king” in Humboldt after decades of entrenched use, Ernie Stewart, the Chief Deputy Coroner at the County Sheriff’s Department, said he is certain that the county’s heroin-related overdoses are “way underreported.” He said meth and heroin abuse has touched every type of person locally, not just the homeless.

With the sharp increases in use and overdoses, syringe litter has become a significant flash point for the town’s middle-class residents, particularly because tourism is so important for Eureka and the surrounding region. The town’s homeless have borne the brunt of the blame and frustration. Many Eurekans described various shocking experiences, including witnessing injections on public streets. They worry that discarded syringes could threaten children and tourists playing in the area’s parks.

The Humboldt Area Center for Harm Reduction, which distributes clean needles through a syringe exchange program, has also drawn the ire of many in the community who blame the organization for the proliferation of needles. Brandie Wilson founded the organization in 2014 in part to combat the spread of hepatitis C, which is widespread in Humboldt County. The exchange, Ms. Wilson said, has distributed close to one million clean syringes since 2017. Data provided by Ms. Wilson showed that it gets about 94 percent of them back again.

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Homeless people walked on West Third Street near a charitable soup kitchen in Eureka.CreditMax Whittaker for The New York Times

“Our Hep C and mental health and drug use and homeless and opioid use issues, all of those are so intertwined with being rural, and with a culture of silence,” she said. “No matter where I looked, there was no help. There was no help.”

Ms. Wilson said the organization has also distributed thousands of kits of naloxone, a medication used to reverse opioid overdoses.

The needle litter problem intensified two years ago when the town removed a homeless encampment along the Palco Marsh where somewhere between 250 and 400 homeless people had been sleeping.

City officials and health service workers had encouraged the town’s large homeless population for years to go there. The tent city, which was colloquially called Devil’s Playground, provided a place to sleep and to linger during the day, but it also saw severely unsanitary health conditions and, at times, violence. In 2016, the town decided to clear the camp to install a bike path along the water, and did not allow a new camp anywhere else.

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Michael Poirier, who is homeless, read the New Testament on a vacant loading dock on West Third Street near the soup kitchen.CreditMax Whittaker for The New York Times

Now “everybody wants to focus on syringes instead of lives,” said Ms. Wilson.

[We’re interested in hearing from people who live in rural communities in California. What are the main issues facing your area? What do you think has not received enough attention? Email our reporter Jose A. Del Real at jose.delreal@nytimes.com or join the discussion in California Today. Please include your name, town, and a phone number if you would like us to follow up.]

Ms. Cobine said that the town’s decision to clear the homeless encampment “tore us down emotionally and psychologically.” Ms. Cobine said she stopped taking her medications for bipolar disorder because she was afraid that a side effect, drowsiness, could leave her vulnerable to sexual assault when she did not have somewhere safe to sleep; she carries a hatchet around in her bag for protection.

“They shouldn’t have closed the playground down if they didn’t want homeless people all over town,” Ms. Cobine said. “They should have let them stay back there where they were, if they didn’t want drug paraphernalia all over town, or give us somewhere else to go.” She noted that just a fraction of the town’s homeless who were living in the tent city found accommodations through support programs.

Steve Shockley said he and other homeless people in the area do not just use meth recreationally: they often use it to stay awake at night. The homeless in town have fewer and fewer places where they can sleep without risking a ticket for loitering, or having their few possessions seized by the police. So they take meth to keep moving at night, and take heroin during the day to feed their cravings.

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Stacy Cobine and Steve Shockley smoked meth in her motel room. A heavy drug user who has been homeless for much of her life, Ms. Cobine was able to afford a motel stay with money from a settlement after she was hit by a car.CreditMax Whittaker for The New York Times

Another homeless man, Michael Myers, said that heroin was easier to acquire than meth or on some days, even marijuana, which is surprising in a region known as the Emerald Triangle where marijuana is widely grown.

If there has been a saving grace in Northern California, it is that a much more powerful illicit opioid, fentanyl, is far less common on the West Coast than in other parts of the country. Fentanyl, which is 50 times as strong as heroin, is increasingly being mixed into batches of heroin and is largely responsible for the devastating rise in opioid-related deaths nationally.

Unlike the supply of heroin primarily found on the East Coast, the so-called Black Tar heroin seen in the West is harder to mix with fentanyl, according to public health experts.

But even without fentanyl, Humboldt County is ill equipped to handle rising heroin abuse and addiction. Access to medication-assisted treatment for opioid abuse disorder is severely limited in these remote parts of California — a problem shared by rural counties across the country.

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Eureka is remote from California’s main population centers, and its problems are often overlooked by the rest of the state, residents say.CreditMax Whittaker for The New York Times

“The state is failing miserably, and you can quote me on that,” said Mr. Stewart, the deputy coroner. “The state is failing miserably across the board. They are not putting enough funding and resources toward rehabilitation.”

Mike McGuire, who represents several Northern California counties including Humboldt in the State Senate, said that government leaders needed to be more proactive about expanding resources in rural parts of the state. He said rural Californians are “desperate” for more assistance.

“Humboldt County is just a few hours up Highway 101,” he said, “but as an individual travels further north on the highway, it’s like you take a step back in time. We need to step up to the plate and provide rural counties with the tools they need to combat this crisis.”

Mr. McGuire said that between 500 and 700 residents of Humboldt and nearby Trinity and Del Norte counties are on a waiting list for opioid treatment services.

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Mr. Shockley said that homeless people like him in Eureka use meth at night to keep moving, because there are few places where the police will let them sleep. He kissed his fiancée, Phenicia, on West Third Street.CreditMax Whittaker for The New York Times

Marlies Perez, the chief of the California Department of Health Care Services’ Substance Use Disorder Compliance Division, said the state is working on increasing the number of treatment options available in rural areas.

“One of the problems is stigma,” Ms. Perez said. “We have county supervisors who don’t want a treatment program located in their area.”

Some options are on the way. The treatment provider Aegis is scheduled to assist in opening a center just outside Eureka by early 2019. The hub is meant to treat up to 200 patients and to serve as a center for smaller “spoke” centers in the region, including Del Norte and Trinity counties.

Once there are more treatment options in place, the challenge will be getting the people who need them most to buy in, and to offer them mental health services as well.

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Eureka, on Humboldt Bay in California’s North Coast region, depends on tourism. Residents worry that a growing heroin problem will deter visitors.CreditMax Whittaker for The New York Times

“Every time I’m almost off this” stuff, said Mr. Shockley, “somebody dies — which is kind of a cop out. But it is what it is.”

Ms. Cobine, for her part, believes that housing needs to be the priority in a comprehensive program to deal with drug use in the area.

“I don’t know why treatment and rehab and these services always have to come into play first,” said Ms. Cobine. “If there was just affordable housing, people wouldn’t be using as much.”

Finding stable housing situations for those who are most vulnerable, to encourage recovery, is another challenge. Sally Hewitt of the Humboldt County Department of Health and Human Services said the county’s inability to expand public housing options will make that far more difficult, particularly because of local resistance.

As a result of restrictions on public housing development in California, Ms. Hewitt said, county officials must largely deal with private landlords when seeking to house the homeless. Many of the landlords require potential tenants to have references, good credit and an income at least three times the cost of rent. Those are each obstacles for the homeless, particularly those with drug addictions.

While the county seeks solutions to those systemic issues, Ms. Wilson said her organization will continue distributing needles in the region, despite opposition from town residents and despite efforts by the City Council to regulate her organization more heavily.

“We’re just trying to figure out how to keep people alive while we wait for more treatment up here,” Ms. Wilson said.

A version of this article appears in print on , on Page A14 of the New York edition with the headline: Needle by Needle, Crisis Grips California’s Rural North. Order Reprints | Today’s Paper | Subscribe